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Episode: How can we prevent physician suicides? A conversation with Dr Christine Yu Moutier

Author: Michelle Chestovich MD
Duration: 00:41:42

Episode Shownotes

Physician life coach Michelle Chestovich MD has a conversation with Dr Christine Yu Moutier, the CMO of American Foundation for Suicide Prevention. We discussed risk factors and ways individuals and organizations can better support physician mental health. A must listen and please share with your organization to be apart of

small changes that work.Learn more about the work being done at American Foundation for Suicide Prevention and get involved: https://afsp.org/

Full Transcript

00:00:00 Speaker_01
You are listening to Episode 193 of the Remind Yourself Podcast. Welcome to the Remind Yourself Podcast, the podcast for physician moms just like you who want to ditch mom guilt, stop yelling, and start enjoying their lives today.

00:00:21 Speaker_01
I'm your host, Rachelle Chestevich, certified life coach, family physician, and mom of four. If you want to overcome overwhelm for once and for all, this is the place for you. Hello, Mama Docs, and welcome back.

00:00:39 Speaker_01
Today, I am so honored to have a privileged guest coming on and speaking about her expertise on suicide prevention.

00:00:47 Speaker_01
Dr. Christine U. Moutier serves as the chief medical officer of the American Foundation for Suicide Prevention, and she knows the impact of suicide firsthand.

00:00:57 Speaker_01
After her own lived experience and losing physician colleagues to suicide, she dedicated herself to fighting this leading cause of death. For the past decade as CMO, Dr. Moutier has been leading a nationwide movement fueled by science and grassroots.

00:01:13 Speaker_01
I'm so honored to have a conversation and welcome Dr. Christine U. Moutier.

00:01:19 Speaker_00
Thank you, Michelle. It's such a pleasure to come on to meet your community and hopefully, you know, really have a discussion that that is relevant for all of us in our everyday lives.

00:01:32 Speaker_01
Yes. And I am so grateful for you taking time to be here. And what I'd like to do today is talk about how you got into the work you're doing.

00:01:41 Speaker_01
And then again, as physicians, my listeners have heard me share my sister's story, which, in fact, is how you and I met years ago after Gretchen died.

00:01:50 Speaker_01
There was a coaching program and you were invited to speak and I was invited to share Gretchen's story. And we met sort of at that time, about three years ago. And I've just learned more about you and admired the work that you've done.

00:02:03 Speaker_01
And I thought, wow, what an amazing human. And I want you to come on and share it is how you got into that area and what we as physicians can do to help ourselves and our patients.

00:02:15 Speaker_00
Absolutely. I just really thank you for allowing space and time, again, for me to speak with you and to really reach your community.

00:02:27 Speaker_00
It's very, very important with everything going on in our busy lives and in physicians' work and health professionals more broadly as well.

00:02:36 Speaker_00
My own story and how I came to devote my entire life's work to suicide prevention and suicide loss and healing and support. As a psychiatrist, you might think that it's through patient care and just clinical, you know, scientific work.

00:02:51 Speaker_00
But my own journey really started with my own lived experience while I was a medical student, followed by a series of losses that touched me personally. One medical student I had worked with very closely as a resident, when I was a resident.

00:03:05 Speaker_00
And then over the course of the next about 15 years, as I moved from residency to faculty at University of California, San Diego, there were more than a dozen physicians who died by suicide over that 15-year period.

00:03:20 Speaker_00
and they were across all specialties. But by that point in time, several years into my career, it was early and it was kind of odd and interesting. I became a dean in the School of Medicine, Assistant Dean for Student Affairs and Medical Education.

00:03:34 Speaker_00
And that platform, my sort of secret mission in even taking that job and even staying in academic medicine, related to the culture around mental health. and suicide risk that I had experienced myself so viscerally.

00:03:51 Speaker_00
And then with those losses as well, just really passionate about trying to make a difference and change the culture and elevate opportunities to be more authentic and to get the help that we need. We all face challenges. Physicians are humans.

00:04:04 Speaker_00
And so in the work I was doing at UCSD, part of that was, along with my mentor, Sid Zisook, designing a suicide prevention program that was more than just suicide prevention.

00:04:17 Speaker_00
It was wellness, burnout prevention, the whole spectrum of well-being, all the way to trying to stem the tide of these suicides that were occurring at that time.

00:04:31 Speaker_00
That really gave me the opportunity to search deeply in the literature and in the public health model. What do we know about what drives suicide risk in a learning and in a working environment? Is suicide a complex health outcome?

00:04:46 Speaker_00
And if so, and in fact, I will just say the science does bear that out, but at that time in the early 2000s, the science was less far along. And so even over the last couple of decades, we know a lot more now. than we did then.

00:05:00 Speaker_00
But I found the American Foundation for Suicide Prevention in our search for models and programs, and AFSP has a program called the Interactive Screening Program, or ISP, that we found and continues to serve as the heart of UCSD's HEAR program, which is the program we ultimately developed.

00:05:21 Speaker_00
And HEAR stands for Healer Education Assessment and Referral. And so

00:05:27 Speaker_00
Fast forward then, I had found AFSP, I became a volunteer, I helped start the San Diego chapter, and then 11, 12 years ago when they needed their next chief medical officer, that's how I ended up moving from San Diego to the East Coast where AFSP is based in New York City.

00:05:46 Speaker_00
AFSP is a national organization. And I could say more about, you know, the work that we do at AFSP, but it is a passion.

00:05:53 Speaker_00
It remains a privilege to be involved in supporting the scientific community and the nationwide network of grassroots chapters, real people, families who are all personally touched by suicide, and to see how that science meets real life and real world experience.

00:06:13 Speaker_00
to catalyze change at the federal, state advocacy levels, but also across industries. We really see suicide prevention as not just a scientific or a clinical endeavor, but something that needs to be infused into

00:06:32 Speaker_00
all of the places where we work, live, pray, play, everything. And that's, in fact, that's community-based suicide prevention. And of course, there's also clinical suicide prevention intervention steps now. So that's a little bit about my story.

00:06:47 Speaker_00
I also have family members who have their own lived experience and so have learned kind of the journey of supporting loved ones. And so it's kind of a 360 personal and professional thing for me.

00:07:02 Speaker_01
I love that. And it makes sense having that actual experience in so many different arenas that you're able to do this amazing work. And I love the way you describe it. I mean, it really is a nationwide and yet very granular in the communities, right?

00:07:18 Speaker_01
I was looking up recently in September, it's National Suicide Awareness Month, Prevention Month, Awareness Month, and, you know, looking up where were their local walks. And I just, it made my heart sad and yet

00:07:31 Speaker_01
fill with joy that there were so many places, even across, you know, the Midwest, in Minnesota, in Iowa, different places where I had been that month. that are doing this. And again, I know it's all over the nation.

00:07:42 Speaker_01
Of course, for me, and I would love to hear, you know, the work that you folks do. It's amazing work.

00:07:47 Speaker_01
And the work that was also started at the hospital, because again, after losing Gretchen, I looked up and you probably know the statistics better than I, but I learned like physicians, we lose them at an outstanding rate, more than the general population.

00:08:03 Speaker_01
And that blew my mind. And of course, I, in my frantic-ish state, think, oh, my God, what are we going to do to fix it today so this doesn't keep happening?

00:08:13 Speaker_01
And I know progress has been made, but I feel like I'm still so up close and personal to it and still hear a lot of situations where people are dying by suicide. I would love a bigger perspective of it all. Where are we at?

00:08:25 Speaker_01
And tell us the ways that we are making progress, because I know we are. But of course, I want it to have been done yesterday, so I need to take a deep breath and listen to the experts.

00:08:36 Speaker_00
Yeah, no, no, I appreciate your sense of urgency is totally valid and a critical part of how the movement of suicide prevention is being fueled. Unfortunately, a lot of it is through tragedy, but I will say that the way that I view

00:08:54 Speaker_00
suicide, you know, the research shows that it's a complex health outcome and health issue. And by that I mean, you know, biological, genetic, environmental, early childhood, culture, policies, access to care.

00:09:09 Speaker_00
And if you think about other complex health outcomes, all that same list of risk and protective factors applies to heart disease outcomes, even some cancer outcomes, and many, many other health issues.

00:09:21 Speaker_00
So keeping it in the health framework always helps ground me when we start reverting back to, in a way, the confusion of the past before we had scientific discovery.

00:09:32 Speaker_00
So I'd say that where we are, and I do view suicide prevention and moving the needle on a very complicated and previously highly stigmatized issue, that this is long game work.

00:09:48 Speaker_00
but that there are key levers that if we can figure, well, we need the science to say what drives risk and what constitutes effective prevention strategies and intervention, and then find the levers that if you press on them, that's going to be the way that risk factors can be reduced and protective factors can be enhanced.

00:10:09 Speaker_00
for at a population level, let alone in the public health model. The more you get into the higher tiers of selective and targeted interventions, if we can identify who are at higher risk, then of course those can be more finely tuned.

00:10:25 Speaker_00
But it has to be all of it, the universal layer as well as the tiered approach towards at-risk populations.

00:10:33 Speaker_00
So in the physician suicide prevention realm, I would say that we know more about what risk factors might look slightly different as an overall picture compared to general population suicide decedents.

00:10:50 Speaker_00
And those have to do with our sense of identity as physicians and the culture that we live and work in, which is a constant interaction between internal perceptions and the external realities.

00:11:03 Speaker_00
But of course, sometimes our internal, our mind is our great mediator between the outside and our internal perspective. And so sometimes it is our perceptions around what is and isn't okay to do, namely help seeking and engaging in treatment.

00:11:21 Speaker_00
But I'd say where the needle is moving the fastest and the most critically is around changing the questions that

00:11:28 Speaker_00
are illegal on medical and nursing licensing forms and and, you know, recertification that previously in most states now the change is happening previously really did illegally single out mental health or substance use in a way that didn't treat mental health as a true aspect of human health.

00:11:49 Speaker_01
Right, and added to the huge stigma.

00:11:51 Speaker_01
So what I'm hearing you say is this very important work is turning down the dial on the stigma so people realize like, oh yeah, I have a brain that can get sick too and I get help and it doesn't stop me from doing my job.

00:12:01 Speaker_01
Because I think that that has been a huge contributing factor over the years. It sounds like you agree with that. I love the way that you even just talk about like, okay, let's take a look at the bigger picture and there are all these steps.

00:12:13 Speaker_01
I'm like, oh yes, there has been so much progress. That's huge. You know, and I feel like my mission on Earth is to keep talking about it. So people are talking about it to reduce the stigma as well. Yeah. Yeah.

00:12:25 Speaker_01
Highly amazing, highly awarded folks who appear to be having it all together might not. And they can die by suicide as well. And so that's I feel like the work that I'm doing to turn the dial. And I hear you saying that's a part of it. Yeah.

00:12:40 Speaker_01
And looking really closely at what our particular risk factors are, because I feel like I could list a whole bunch of things that put people at risk for suicide and where we physicians are.

00:12:49 Speaker_01
And it sounds like you're saying the stigma and the culture are pretty big.

00:12:54 Speaker_00
Yeah. And I think, you know,

00:12:57 Speaker_00
if we can shift the culture so that our sense of identity can be more holistic, compassionate, forgiving, incorporate the philosophy of it's about progress, not perfection, because that's a much healthier and more reality-oriented way to live, even as a physician, even where

00:13:17 Speaker_00
I will go so far as to say that medical errors in our patient care would improve if we adopted that philosophy.

00:13:25 Speaker_00
And that might sound very kind of paradoxical for some, but I've just seen how that works, where when you allow yourself to breathe and admit what you don't know, then you can actually learn.

00:13:36 Speaker_00
And when you can admit that I'm vulnerable in these areas of my health or mental health, then you can actually be proactive and you don't have to avoid, minimize, go into state of denial while that health issue gets worse and worse.

00:13:50 Speaker_00
And that's what I would say can happen in the case of suicide risk. Right.

00:13:56 Speaker_01
Like shame, right? When you're trying to hide, then shame amplifies. And that probably isn't helping your mental health if you're already struggling.

00:14:03 Speaker_00
Well, and shame is such a, I'm glad you brought it up, because the experience of shame can link up with perceptions, and I will say distorted perceptions, because our brains are like that.

00:14:15 Speaker_00
It doesn't matter if we're in our best state of health, our brains will still distort the narrative. It's just part of being human. When we become depressed, anxious, traumatized, sleep deprived, then our brain does that trick on us even more.

00:14:31 Speaker_00
And so that sense of shame can sync up with a sense of worthlessness, helplessness, hopelessness. And I think as physicians, I just have come to believe that

00:14:45 Speaker_00
We're, of course, we're all unique and different individuals, but something drives us towards this profession in a way that we might be wired just a bit more for a little extra, the old term was neuroticism.

00:15:00 Speaker_00
You know, we just wanna, we wanna do good, we wanna help, we wanna think and overthink. And in our professional life, if we're not afforded the opportunity to balance that out, again, with a experience of,

00:15:15 Speaker_00
Rest, support, learning that debriefing conflict and difficult days with each other can mean everything, can mean the difference between an escalation of burnout into other clinical states that we may be vulnerable to for no

00:15:33 Speaker_00
fault of our own, but through our genetic loading or through early childhood experiences towards depression, anxiety, PTSD, or addiction.

00:15:41 Speaker_00
That's across the human race, and physicians are no different, except that what is done to us and what we do to ourselves in our professional life can harm us in that regard. It's kind of a holistic look at

00:15:59 Speaker_00
how that works internally and externally because I never want to put the blame on any individual.

00:16:05 Speaker_00
It is incumbent upon institutions to shape and reshape culture through leadership, through policies, through informal storytelling, just like you're saying you are raising awareness and by telling your story,

00:16:19 Speaker_00
and also by allowing others to tell their story of how they got help changed the game for them. I mean, that's certainly part of my story. That can resonate for somebody who's suffering right now and not sure what to do.

00:16:33 Speaker_01
Right. I love that too. I've had people come on and share their story, how it was nearly them. And I share often that people just come up to me and say, you know, I heard your sister's story and I was having a very hard time.

00:16:42 Speaker_01
I was thinking about driving off the road, but I remembered your sister and I got help. So again, it's all of these collective stories and sharing not only like to stop the stigma.

00:16:53 Speaker_01
But I'm also hearing you say that there are really good things that we can do that are protective. Sure, we're kind of in hot water as physicians and we have some risk factors because we're so driven.

00:17:02 Speaker_01
But even the piece that you said about the thought distortions and kind of spinning and ruminating in that, I didn't even know that thoughts were not me until I started with coaching five years ago. Like, it blew my mind.

00:17:16 Speaker_01
Like, I was age 45 and I realized that I was separate from my thoughts. I just thought because I had a thought over and over again, it was true. Like, you're a horrible mom. Like, I thought that was truth.

00:17:27 Speaker_01
No, that's just like a thought I've had again and again, but I can actually be deliberate and remember all these other things. So even just like, tell me about that.

00:17:34 Speaker_01
So for me, I'm such a believer in like, let's talk about the stigma, but let's do things ahead of time to like protect yourself.

00:17:41 Speaker_00
Yes.

00:17:42 Speaker_01
You know, with even understanding, I mean, you're in psychiatry, so you probably well aware in your training knew about thought distortions and all these things, but a lot of us don't.

00:17:51 Speaker_00
get taught that. Right. I mean, I honestly wish that and maybe there is an opportunity with some of the states passing laws around K-12 social emotional learning curricula.

00:18:03 Speaker_00
Like what you just said, that should be taught to every child as you're growing up that who you are It's a very understandable conflation because our thoughts are happening in our brains. We're experiencing them as our own selves.

00:18:23 Speaker_00
Personality is oftentimes conflated with behaviors. I love that you're highlighting that discovery because

00:18:32 Speaker_00
Coaching, certainly therapy, cognitive behavioral therapy, it's all about identifying where those cognitive distortions, and in the CBT literature they're called automatic thoughts.

00:18:47 Speaker_00
something happens and it triggers that same reflexive, negative, usually negatively distorted thought over and over. I'm a failure. If somebody looked at me that way, I'm socially awkward. I don't deserve friendship.

00:19:02 Speaker_00
Whatever it is that gets and oftentimes is linked up with, again, so many earlier experiences but also genetics and also the current environment we're in and whether we're availing ourselves of

00:19:16 Speaker_00
you know, call it innovative or modern, but it's really just kind of basic methods to be able to reframe and identify. It's hard to do when it's happening in your own brain, but you can learn to do it.

00:19:31 Speaker_01
Absolutely. And again, I think just I love normalizing. We're humans. Life on Earth here is challenging. And like my patients, I was sending everybody to therapy. I'm like, life is hard. We should be born and given a therapist. I still believe that.

00:19:44 Speaker_01
I think it's so true to journey with someone outside of you to tell you a little objectively or to teach us. I mean, we physicians may be a little nerdy and like to learn things like, oh, Interesting. That's called a thought distortion.

00:19:54 Speaker_01
I have that all the time, this particular pattern. But you can learn to just realize like, oh, there it is again. And how can I reframe it? So I just love that.

00:20:03 Speaker_01
And I know that some organizations are starting to do this work, whether it's, you know, offering therapy and or EAP or coaching. So what are you seeing as something that would be helpful?

00:20:16 Speaker_01
If you could wave your magic wand, wouldn't that be great, across the nation and set up an ideal program in institutions? Because this is beyond the individual. What would some thoughts be there?

00:20:29 Speaker_00
Yeah, I've thought a lot about that.

00:20:31 Speaker_00
I mean, institutions have so much opportunity to basically take a look at their policies, their culture, their people's experiences, and then line that up with the ideal public health implementation of suicide prevention, which would look like some universal education,

00:20:51 Speaker_00
some resources that are there in time when people are distressed that allow them to seek the help they need without the usual barriers.

00:21:01 Speaker_00
And by the way, that is the key unique aspect to the interactive screening program is that individuals can remain anonymous while they choose to engage in this screening experience. And then that's just the first step.

00:21:14 Speaker_00
And then it's the dialogue with a real person, a trained counselor.

00:21:18 Speaker_00
So yes, and then peer support can be both a universal, it can also be a targeted, more selective tier of the public health strategy, where let's say, you know, I think about the key moments where people become in transition or vulnerable, when they're being disciplined, when they're moving from one, you know, spot career-wise or life-wise,

00:21:42 Speaker_00
to another. Even positive transitions can actually be vulnerable periods, like starting college or starting med school, starting residency, moving into the clinical work.

00:21:53 Speaker_00
And you look at veteran and military suicide rates as well, and those are the critical junctures in life transitions. Even like the post-discharge literature that shows that patients who are hospitalized or in the ED for suicide risk

00:22:07 Speaker_00
their highest vulnerability are within the few days to a week after they're discharged, and that's those transition points.

00:22:16 Speaker_00
So, applying that into the world of physicians and health professionals, we could be thinking about ways to design extra support around those more difficult periods.

00:22:28 Speaker_01
I love that. And when you said disciplined, another thing that I've heard as well as, for example, someone's been served like medical legal, like a malpractice suit. Yeah.

00:22:37 Speaker_01
And then another thing I've heard just anecdotally from either clients that I've worked with is if the mistake has happened or an unexpected death. And so even if like they're not served, like it's this unexpected thing.

00:22:50 Speaker_01
And if I don't know, again, I was like, where's the SWAT team to come in and surround this human who's really in a vulnerable position?

00:22:57 Speaker_00
Exactly. Yes.

00:22:59 Speaker_00
So, I mean, part of that public health model would mean training everyone at some basic level about suicide prevention, but then giving additional specialized training to, let's say, the risk managers who are actually the ones to interface after the person has been served or after an error has been discovered.

00:23:19 Speaker_00
And what I will just say about that is that suicide risk cuts across all people groups, you know, there's not a group that is immune.

00:23:31 Speaker_00
However, there are known risk factors that when they pile up on each other at a moment of these key stressors, that's kind of the perfect storm period. And so

00:23:43 Speaker_00
If the person is known to, let's say, their colleagues or their department chair for being somebody who has whatever other risk factors, that could be a history of depression, it could be a history of a past attempt, it could be a history of overusing substances,

00:24:00 Speaker_00
It could be just that they're known to be kind of extra obsessive and extra perfectionistic. Those psychological traits are also some of the risk factors.

00:24:10 Speaker_00
So those would be some of the kind of learnings and intelligence that could be brought to bear so that, yes, everyone could receive extra support, but those who are known to have several risk factors and now they're facing this moment of additional stress, they would really receive the most.

00:24:28 Speaker_00
And I feel like We're not behaving that way as systems or in society at all. When someone makes a mistake or if they're facing legal trouble, we've really thrown additional shame their way.

00:24:39 Speaker_00
And so we just need to become much more intelligent and in a way, it's very evidence-informed, but it also allows you to be empathic and compassionate.

00:24:49 Speaker_01
I love that. I love that. And I have a question about how we can do better at improving, you know, these abilities for people to interact with colleagues, that sort of thing. But one other thing I wanted to mention was. the risk of sleep deprivation.

00:25:04 Speaker_01
You had mentioned it earlier. And I think that was a huge leading contributor to my sister's death. Not everything goes through that lens, but it's just like the closest to me to understand. And yes, it was this imperfect storm. It wasn't one thing.

00:25:15 Speaker_01
But the fact that she was sleep deprived tremendously, I think was a huge leading factor. And the fact that I speak about it and people come up to me and say, oh, my goodness, you should have seen what my brain was telling me when I didn't have sleep.

00:25:26 Speaker_01
So what as an organization can we do about that? They did these mandates for like residency hour restrictions. But like, why aren't we taking it seriously? Pilots have work hour restrictions because of like safety.

00:25:39 Speaker_01
I would say that in medicine is also due to safety for the patients, but also ourselves. Could you just speak to how our brain does when it's not getting sleep?

00:25:48 Speaker_00
Oh, I mean, there's no question. Everything you're saying is totally validated. We've seen the research on sleep deprivation is akin to a certain level of intoxication in terms of reaction time, judgment, cognitive abilities.

00:26:02 Speaker_00
But also, in the suicide research literature, sleep is showing up as something akin to a heralding warning sign to also an additional risk factor.

00:26:15 Speaker_01
Mm, interesting.

00:26:16 Speaker_00
Yes. And for young people, it's one of the reasons that we say don't go on social media and screen time before bedtime.

00:26:23 Speaker_00
That interruption of sleep and all the other issues with, you know, the issues around school start time and stop time and sleep is a major, major factor that needs to be paid more attention to. And so I love what you're saying.

00:26:39 Speaker_00
You know, if we were to redesign

00:26:41 Speaker_00
health systems, with thinking about, first of all, with patients actually in mind, and with the professionals and providers in mind as well, we might actually design it around a human-centered approach, where the need for sleep is not viewed as weak, but is viewed as... So novel!

00:27:00 Speaker_01
A human-centered approach! And what's always interesting, right, when we're burnt out and crispy and our brains are so tired, how's our quality, right? Not awesome.

00:27:08 Speaker_01
Our quality and care for our patients and our enjoyment of our job and fulfillment go up when we're taken care of. I mean, that's a whole bigger, bigger issue.

00:27:16 Speaker_01
But it goes back to what you're saying, is that like the solutions, yes, there's real scientific things, but it really is more holistic approach.

00:27:24 Speaker_01
and then layered on how we can care for people and particularly paying attention to people who are maybe at higher risk and vulnerable time. That's right. But I do think even short of redesigning.

00:27:36 Speaker_00
Yeah, yeah, yeah. Right.

00:27:37 Speaker_01
Instead of like scrapping it all, what do we do?

00:27:39 Speaker_00
I know. And I do think that things like ad campaigns that put positive information and inspiring stories and information in front of people on a recurring basis. And that's the thing that these efforts can't be one and done.

00:27:57 Speaker_00
They're oftentimes worked in in a serial manner so that people are seeing the information, the resources, changing the culture around self-care and around accessing mental health support, and also around sleep and around substance use.

00:28:12 Speaker_00
I mean, I think all of those would be some of the basics that could be part of, like, that basic Suicide Prevention 101 universal education that's going on.

00:28:23 Speaker_00
When I had the opportunity to start the HERE program with my mentor Sid Zisak, the first thing we did with our cadre of, we were all kind of volunteering our time to lead this effort, But it was so tremendous and so scary, to be honest with you.

00:28:39 Speaker_00
In the first year when we started the HERE program, we

00:28:43 Speaker_00
offered, well we knocked on every single clinical department, nursing, residency programs, fellowship, the clinical units, everybody's door to ask if we could come in and do an educational presentation.

00:28:57 Speaker_00
And so I think we did something like 40 in the first two years and maybe like 7 in the first year. So it was an experience and This was back in the day when there still was not a lot of talk about suicide. There was starting to be talk about burnout.

00:29:14 Speaker_00
So burnout was a natural entry point. But we literally thought we might get, you know, tomatoes thrown at us, which didn't happen. But we did have a lot of

00:29:23 Speaker_00
really terrible, sarcastic jokes as leaders would introduce us because people just didn't know what to do with the topic. They're inviting us in, but they're also kind of like, in a way, being defensive at the same time.

00:29:36 Speaker_00
So we experienced a lot of just interesting, but again, it's not one and done. So over time, they ask you back and they say, oh, are people really like that? Now they want to know what to do if they're worried about someone.

00:29:50 Speaker_01
So it builds on itself. I love that. I love that. And so then that's the next step is to say, OK, now we're going to teach you some skills. And you had letters for that as well. I can't remember where they are.

00:30:02 Speaker_00
Well, ISP is the Interactive Screening Program. OK. That's a resource that lives out there 24-7 in institutions that choose to utilize it. So it's an institutional decision to host it at their place.

00:30:16 Speaker_00
But yes, the education around what to do if you're worried about someone is very important, and I suppose we could just touch on that.

00:30:24 Speaker_01
Yeah, just briefly. I know we've got it for a bit and we could go on for days, but let's just, yeah, if you could talk a little bit about that, just so people can like think about it and learn more about that.

00:30:34 Speaker_00
Yeah. So I think the main thing is remember that suicidal thoughts are pretty prevalent in the general population, including amongst our colleagues, our students, physicians, nurses, everyone.

00:30:46 Speaker_00
There's a prevalence rate at any given time of between like six and 16% who are having suicidal thoughts. It's a symptom. It's a health experience they're having.

00:30:54 Speaker_00
It's not a matter of, oh, you're impaired and time to rush you to the ER or to report you to the licensing board. That is not it at all. Remember, have a health framework for that. So if you're worried about someone,

00:31:08 Speaker_00
engage them in an open conversation, ideally that's private, that invites them to share.

00:31:13 Speaker_00
If they do start sharing and it does seem like there's hopelessness, worthlessness, feeling like a burden, or just feeling trapped or like overwhelmed, there's a good chance that their mind has gone towards a suicidal thought

00:31:27 Speaker_00
as a way of coping with the pain or the suffering that they're in. So it is important to ask if people are having thoughts of ending their life. And again, it doesn't mean you drop everything and rush them and call 911.

00:31:41 Speaker_00
It means you just stay in the conversation. It is very unlikely that it means they are imminently about to act on those thoughts. That would just be a very rare moment. And in fact, the fact that they're opening up can be helpful and therapeutic.

00:31:54 Speaker_00
And the idea then is that

00:31:57 Speaker_00
Over time, it might be that day, it might be later on, you might play a role in helping them move towards a readiness to get some therapy, see a psychiatrist, talk to their primary care, you know, think about taking a next step.

00:32:12 Speaker_00
Self-care as well, peer support, all of those are reasonable things. I think once somebody has had suicidal thoughts, though, I will say,

00:32:22 Speaker_00
That, to me, does elevate it out of just the self-care and peer support level to seeking professional mental health evaluation and support in some way. It doesn't mean that it's a reportable issue.

00:32:35 Speaker_00
That question still comes up, and I'm just kind of baffled by it. It's a health symptom. And yes, you want to provide care. You don't want to promise confidentiality.

00:32:44 Speaker_00
And you're not their doctor or their therapist, but you can be their friend and supportive colleague and follow up later and continue the dialogue.

00:32:51 Speaker_00
Because if you don't and then they've shared deeply, they're going to think they made a mistake by divulging too much and they're going to worry. So following up is always really important to provide that next touch point and reassurance.

00:33:06 Speaker_01
I love that. And again, this conversation also is, people hearing this, it's reducing the stigma of even the whole suicidal ideation.

00:33:14 Speaker_01
Because I didn't, I thought in the past that suicidal ideation, like many people, that that's like, oh my gosh, it's nearly an emergency. And now I think of it a little differently.

00:33:23 Speaker_01
Like, just because someone's having a little chest pain, a little angina while mowing the lawn doesn't mean I need to call 911 right now and I need to go to the, you know, cath lab.

00:33:31 Speaker_00
Right, it means that something definitely is going a little bit off.

00:33:35 Speaker_01
And so to talk more about it, because again, so many people have shared that they've had these deep, dark, or intrusive thoughts of hurting themselves, and they're safe and well, but

00:33:46 Speaker_01
Whether or not they got help and got, you know, clearly they did get help if they're doing better. But I just think to normalize that there are a lot of people at that level of suffering and that their brain is telling them this. Yeah.

00:33:57 Speaker_01
I don't want to say nonsense, but this idea that that maybe is a way out. And that's a pretty high percentage. What did you say, 6 to 16 percent? Yeah, in any 30-day period.

00:34:09 Speaker_01
Yeah, so let's just start on the baseline like, yeah, people are going to be having this. It's not a problem. It's just sort of like now we need to escalate the help a little bit.

00:34:18 Speaker_00
That's right. I almost view it like you said with chest pain. It's like a warning signal that's indicating that there's something going on that led their mind to search for, we're always thinking of solutions, we're always in a problem-solving mode.

00:34:33 Speaker_00
That's where suicidal thoughts generally come from, is how do I solve this painful, difficult, it can be physical or psychological pain that I'm in, feeling of being trapped. It's a solution-oriented way of thinking.

00:34:47 Speaker_00
But the problem for people who are at higher risk for acting on those thoughts is that research shows their brains actually go towards more of a state of cognitive constriction, even than those who are less at risk.

00:35:01 Speaker_00
So that tunnel vision can be part and parcel to risk. But it doesn't take away from anything you said about it's not always an emergency. In fact, it rarely is.

00:35:13 Speaker_01
I think that's literally blowing my mind right now. We doctors want to know the answers and all the things. It's like, why more we need to be talking about it? This can be going on.

00:35:22 Speaker_01
And if it's going on in your head, I think people think they're going to maybe be locked up in the psychiatric unit. No, this just means that your brain is not doing great right now. And probably a therapist and seeing a doctor would be a great idea.

00:35:35 Speaker_00
Yeah, yeah. It means you're suffering. and the mind went there and it might have been a fleeting thought. So, you know, not all suicidal thoughts are the same either. Very, very, you know, represent different things.

00:35:47 Speaker_00
So it is, it's sort of that indication.

00:35:49 Speaker_00
I like, I like your chest pain analogy because it would say, okay, I think it's time to actually step it up into a level of, you know, cardiac evaluation or primary care and not just kind of the watch and wait mode. Right.

00:36:03 Speaker_00
Although we, I know we docs are like in denial, right?

00:36:05 Speaker_01
Like there've been times where I've had stress in my chest and pressure. I'm like, oh, is this something? No, no, it's fine. Right. So I get it that that's another probably confounding factor for us physicians is that we think, oh, we're going to be OK.

00:36:18 Speaker_00
I don't need help. Well, we're overly stoic. And I want to highlight that.

00:36:23 Speaker_00
going back to the epidemiology, what the data is actually showing most recently is that female physicians, much more so than male physicians, female physicians have higher rates than non-physician females.

00:36:36 Speaker_00
Male physicians, it's not as clear, but for the general population, males die by suicide at almost four times the rate as females. But back to the stoicism,

00:36:46 Speaker_00
I think maybe, additionally, for us as women physicians, we have reasons to believe that we have to go the extra mile. Showing weakness is really not an option, and I think we need to take that mental health experience out of the weakness framework.

00:37:02 Speaker_00
These are aspects of being human, and you're actually going to show strength and protect yourself and your patients if you take care of business, take care of your mental health.

00:37:13 Speaker_01
Yeah, that's how I like to talk about it. I'm like, OK, we have a brain. We spent a whole month of October wearing red for heart health. Let's talk about our brain and taking care of our brain. Right.

00:37:21 Speaker_01
Again, to normalize it and doing things ahead of time. Right. As a primary care preventive kind of doctor, like, that's how my brain works is like, what can we do ahead of time?

00:37:30 Speaker_01
Let's, like you said, start education in grade school, high school about these thought distortions and to normalize this organizationally. Wow, you have such amazing wisdom and seriously, I love that you're taking time to share with my listeners.

00:37:46 Speaker_01
I'm hoping that they're getting some great ideas of how they can change things for themselves and their colleagues and maybe organizationally. Any other things that we didn't touch on that you think would be helpful?

00:37:58 Speaker_00
Yeah, two things.

00:38:01 Speaker_00
Something that anyone can do wearing all the hats we wear in life is that wherever you go, so even if you are rounding with the team on the wards or wherever in your professional life with your work team, infusing some authenticity where you start weaving in the challenges you do face.

00:38:20 Speaker_00
And certainly if you have

00:38:22 Speaker_00
sought-out therapy or any form of mental health support, just sprinkling that in, in casual mentioning, because once we reduce stigma, that becomes kind of like a part of our life that we can choose to share when it's appropriate.

00:38:36 Speaker_00
And that sends the most powerful message to everyone around you that this is a smart, strong thing to do. It's just part and parcel to, you know, helping ourselves and helping each other. One of the things I'll mention is the role of lethal means.

00:38:54 Speaker_00
When friends come to me and they're worried about someone in their own home, in their family, and they've figured out that their teenager or their spouse, whomever, may be at risk or is having suicidal thoughts, the most concrete step you can take, besides facilitating them getting to a mental health professional, is making the home safe and secure of any lethal means.

00:39:17 Speaker_00
And so that's also something that we can obviously do as clinicians as well in our patients who are struggling. And you just would probably not believe how these conversations are acceptable and effective with patients in actually them taking action.

00:39:35 Speaker_00
So there's now more research around lethal means safety counseling and all of the reticence we have because of the firearms, you know, kind of politicization does not have to impede us from having those important conversations.

00:39:50 Speaker_01
Those are like two very practical steps that we can do to help our colleagues and just normalize these conversations.

00:39:58 Speaker_01
Especially I love the bit about the authenticity and vulnerability, because again, that is the ripple effect that like, oh my goodness, this person's amazing. And they see a therapist and they're on searcher lane too. Like, yeah, let's talk about it.

00:40:10 Speaker_01
Yeah, exactly. Yep. Wow. I am so grateful for you taking time and more importantly, for all this work that you're doing nationwide, not only to help raise awareness among physicians, but just as a whole nation, as humans, how can we

00:40:27 Speaker_01
take better care of one another, spot people who are more at risk, and use the science to affect real important change. I'm so grateful for everything that you do.

00:40:38 Speaker_00
Thank you so much, Michelle. And if anyone of your listeners is interested in learning more or getting involved in suicide prevention,

00:40:47 Speaker_00
Our chapter network would so love to meet you because it's, you know, clinical people are much, you know, our treasured resources for the chapter's work.

00:40:59 Speaker_00
Not that you would be providing clinical care, but just, you know, your knowledge and the knowledge of the resources in the local community and so forth. So AFSP.org is the place to learn more about the American Foundation for Suicide Prevention.

00:41:13 Speaker_00
So thank you so, so much, Michelle. It's really been a pleasure.

00:41:17 Speaker_01
Thank you. I appreciate you. Are you ready to take control of your life and put these tools into action? I'm here to help. I offer free consultations for physician moms to see if my one-on-one coaching package is right for you.

00:41:31 Speaker_01
You can sign up for a free consult at www.MamaDocLifeCoach.com.